👁 What if IOP rises again after trabeculectomy?
Although trabeculectomy usually controls IOP well in early stages,
bleb fibrosis or adhesion may cause IOP elevation later.
➡ Post-op management becomes crucial.
💧 1. Digital Massage
- Indicated if IOP > 12 mmHg in early phase
- Gently press the lower eyelid with the index finger for 10 seconds
- Stimulates aqueous flow through bleb
- Alternate: CTM (Carlo Traverso Maneuver)
- Uses a cotton swab to press over the scleral flap at slit lamp
🪡 2. Needle Revision (NR)
- Uses a 26G needle to physically break adhesions under the conjunctiva
- Expands the bleb space and restores outflow
- Often combined with 5-FU injections to suppress fibrosis
✅ High-risk cases: 1–2 injections per day starting day 1–2
✅ Low-risk: every 2–3 days as needed
✅ Summary
- Surgery is not the end — it may require ongoing management
- Digital massage & needle revision can restore failed blebs
- Persistent high IOP → resume drops or consider repeat glaucoma surgery
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